3 Trends in Cardiology Compensation and Workload

Cardiology practices are facing increased pressure on revenues due largely to significant cuts in the Medicare fee schedule for these services. Such cuts threaten the profitability of practices, making benchmarking and performance monitoring even more critical for cardiology practices today than in the past. MedAxiom, a cardiology practice benchmarking and consulting firm, collects data annually from 150 cardiology practices around the country on compensation, overhead costs, patient load and overall performance. Patrick White, president of MedAxiom, shares three trends in cardiologist workload and compensation.

1. Decreased compensation. According to Mr. White, cardiologist salaries dropped slightly in 2009, from $472,000 to $460,000 — a decrease that will be even more pronounced in 2010, he predicts. The decrease in compensation is caused by a number of factors, but MedAxiom reports show that the driving force is the "tremendous cuts in the fee schedules." In the last year, fees for cardiology services were lowered, and many CPT billing codes were bundled so that a procedure that might have used three CPT codes in the past now only needs one.

According to Mr. White, it is becoming increasingly more difficult to survive as a cardiologist in private practice. "The threat to working in a private environment is so significant that they're saying, 'I'm going to partner with my hospital, sell or lease to that organization.'," says Mr. White. "Trying to survive as an independent practice and buy equipment and hire staff is difficult when you don't know how much you're going to make that year."

2. Fewer cardiologists and more patients. Mr. White says that as the baby boomer generation hits the age when cardiovascular disease becomes prevalent, more patients are meeting a shortage of cardiologists. According to the MedAxiom 2009 report, 43 percent of cardiologists are over 50, meaning that almost half the cardiologist population will be retiring in the next 20 years. New patients coming to hospitals for cardiology services rose from 630 to 645 per physician last year, and return visits, including long-term care for heart failure and lipid disorders, rose too. "It used to be that cardiology was a consultative practice, where a primary care physician would send me a patient and I'd send him back," Mr. White says. "Now cardiologists hang on to patients, and patients keep coming back to be managed."

The culture of the baby boomer generation also had an effect on the spike in patient visits, according to Mr. White. "This new generation of baby boomers is different from our parents and grandparents," Mr. White says. "We are more likely to understand that if we have chest pains, we should get to the doctor right away."

The current shortage of cardiologists is exacerbated by lower numbers of medical students choosing cardiology as a specialty.

3. Cardiologists working harder and more efficiently. Mr. White says that in this economic climate, cardiologists are being forced to work longer hours, accept more patients and streamline their practices. While physician overhead dropped on average in 2009 — the first year that it has done so since 2002 — cuts in fee schedules and bundled CPT codes mean that overall compensation is down.

According to Mr. White, cardiologists are working hard to make their practices more efficient. This sometimes means whittling your practice down to a strong core team of people instead of hiring a lot of extraneous help. As a specialty, cardiologists have also adopted EHR and EMR more quickly than other providers. While this might cause inefficiencies during the implementation process, Mr. White says "once providers have achieved efficiency with the system, it helps significantly to be involved in e-prescribing and PQRI."

At this point, about 60 percent of MedAxiom's 150 cardiology practice clients are using an EMR, says Mr. White.

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